| NPI | 1548257058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 202K00000X (Licence: NC ME74461) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: FL ME74461) |
| 207K00000X Allergy & Immunology (Licence: TN 42176) | |
| 207P00000X Emergency Medicine (Licence: NC 2007-00905) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2012-03-16 |